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138
Annual Report of the London County Council, 1913.
With few exceptions they came into the operating room without fear, and took the anæsthetic without
struggling. It would be well to arrange if possible for the children operated upon to return to
the centre for instruction in breathing exercises until they learn to breathe quite naturally through
the nose with the mouth shut, so that children who remain mouth breathers, even when the nasopharynx
has been satisfactorily cleared, may have a normal condition established.
Ringworm.—The objections formerly raised by parents to the X-ray treatment of their
children for this ailment appear to be diminishing, and some of the centres had quite considerable
waiting lists. Having regard to this fact ringworm was added to the classes of ailments already
treated at two existing centres and the numbers of cases under agreement at other centres was
increased.
Nursing treatment.—Under this heading are included the cases hitherto described as "minor
ailments." The early arrangements for this branch of treatment provided that 25 new cases should
be referred to the centre each week. In practice, however, these numbers were found to be unmanageable,
and, owing to the steady accumulation of old cases attending for continuing treatment, caused
undue congestion and difficulty. During the year, therefore, the average weekly number of new cases
referred to each centre was reduced to 15. At the same time, moreover, the centre authorities were
guaranteed a capitation payment of 4d. for all the cases for which provision was made. Although
the immediate effect of the altered arrangement was to reduce the provision made at each centre, it
was thought better to compensate for the reduction by the establishment of new centres in convenient
positions rather than by increasing the facilities at existing centres. This policy is still being pursued,
and at the end of the year arrangements had been made for the treatment of 12,320 cases as against
12,540 cases in 1912 when the provision made was on the basis of 25 new cases a week at each
centre. Further centres, moreover, are contemplated, and at the time of writing there is already
available accommodation for some 2,000 additional cases which is to be increased to 4,000 in the
immediate future. Thus there will shortly be some 23 centres providing for more than 16,000
children, instead of, as at the end of 1912, 12 centres providing for 12,540 children.
Teeth.—The greatest increase, however, has taken place in the provision made for the treatment
of dental defects, the actual numbers arranged for at the end of 1913 being 31,240, as against 18,850
at the end of 1912. This increase shows that considerable effort has been made to deal with the great
need that existed for this branch of treatment, but there is yet necessity for further provision, which
is being met by the establishment of fresh centres, and arrangements are already completed or in
progress for the treatment of some 10,000 additional cases annually.

During the year it was found advisable to amend in some respects the terms of agreement
with the various committees providing facilities for the treatment of school children, more especially
as regards the payments to be made by the Council. For instance, it had been the practice generally
for such payments to be made on the basis of £50 per annum for each doctor, surgeon, or anæsthetist
employed on one half-day a week, and pro rata for every half-day so worked. In addition, a
capitation payment was made of 2s. for each major ailment treated in respect of defects of the eye,
ear, nose and throat, and teeth, and 7s. for the X-ray treatment of ringworm. The new agreements
provide for the same rate of payment as regards the services of a doctor, surgeon and anaesthetist, and
as regards the capitation fees for ringworm, and eye, ear, nose and throat defects, but in the case of the
older dental centres where the initial expense of establishment has to some extent been met, the
capitation fee has been reduced to 1s. for all cases treated during the year in excess of 1,000.
All new dental agreements, moreover, provide that the half-time services of a dentist including
inspection and treatment shall be paid for at a rate not exceeding £200 a year. At all the centres
treating major ailments the services of a nurse are provided by the Council, and in some cases
additional assistance is given by arrangement with nursing associations which also undertake the
treatment of minor ailments, the Council paying £50 a year for the services of a doctor on one
half-day a week, and £100 for the equivalent of the whole time services of a nurse, including the
cost of equipment, travelling expenses, &c. In some cases a small grant of £12 10s. is made
towards the first year's rent at nursing treatment centres where the initial expense is heavy, and in
all cases a capitation fee of 4d. is guaranteed on the number of cases for which agreement is made.
Upon the establishment of a new centre the Council makes a grant of £100 for equipment for
the purposes of medical treatment, £50 for dental treatment, and £75 for X-ray apparatus, but all
the material purchased under these grants remains the property of the Council, and by the terms of
the agreement is to be returned on the expiry of the contract.
At the suggestion of the Board of Education the new agreements with committees of local
medical practitioners now contain a clause securing that the work of the centre shall be under the
general supervision of the school medical officer. This supervision is parried out through the